[34] in 2010, selleck chem Enzalutamide only 3 of 47 patients were converted to open surgery after attempts failed to reach adequate exposure for resection. Predictors of a difficult access include: retro- and micrognathia and trismus. Other studies demonstrate comparable case exclusion rates, such as Boudreaux et al. [32], who reported 3 of 29, and Iseli et al. [33] found 5 of 54. Moore et al. [8] reported no case exclusion due to unsuitable access. A comprehensive panendoscopy prior to scheduling patients for TORS can identify unsuitable patients and thus reduce surgical risk [40]. Weinstein et al. [34] also report a successful swallowing rate of 97.6% at 12-month followup, while Boudreaux et al. [32] found 79% at last follow up (3 months), and Iseli’s study [33] found 83% (12 months of followup). Moore et al.

[8] report that all patients returned to normal swallowing (followup time ranged 3 months to 2 years). Predictive factors of poor swallowing following robotic resection included: higher TNM stage, preoperative nasogastric feeding requirement, tumor site (oropharyngeal or laryngeal), and recurrent or second primary tumor resection [33]. Regarding the overall procedure time, we observed a trend to faster procedure times as more cases were being performed. Lawson et al. [15] assessed the robotic learning curve for procedures in the head and neck and found that both set-up and operative times showed a reduction in time as more procedures were performed. For the operative segment, time was reduced from 88��53 to 47��29 minutes. For the overall procedure, time was reduced from 117��64 to 66��33 minutes.

However, the time taken for exposure was not reduced with experience. Another important outcome to consider is recurrence rate after TORS. Although there are no studies assessing recurrence rates at 5 years, preliminary outcomes have been encouraging. In Weinstein’s report of advanced oropharyngeal carcinoma, regional control was obtained in 96% and distant control in 91% of cases at 18 months follow up [34]. Accordingly with Machtay et al. [41], local control was always achieved if negative oncological margins were obtained. The robot can thus provide an excellent approach to cancer, improving the ability to interpret the adequacy of the resection margins��an important factor in determining whether adjuvant therapy is indicated [42].

Further studies are needed to assess the short- and long-term outcomes of TORS when compared to other more established techniques Table 1. Table 1 Major clinical series in oncologic TORS. 7.2. Benign Head-Neck (TORS) The first published clinical application of TORS, performed by MacLeod and Melder, was marsupialization of a vallecular cyst [12]. Vicini et al. assessed the effectiveness Drug_discovery of robot-assisted surgery in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) [44, 45].